Healthcare Provider Details

I. General information

NPI: 1871083840
Provider Name (Legal Business Name): BROOKE HUSTEDT SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CALHOUN ST
CHARLESTON SC
29401-3538
US

IV. Provider business mailing address

105 MARKET BAY CT
SIMPSONVILLE SC
29681-2706
US

V. Phone/Fax

Practice location:
  • Phone: 843-937-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7802
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: